Izaak Walton Killam Health Centre

Volunteer firefighters face elevated cancer risks from exposure to combustion by-products, exacerbated by limited decontamination resources, especially in rural departments. This proof-of-concept study assessed the feasibility and preliminary effectiveness of an online educational intervention to improve cancer prevention behaviors among Canadian English and French volunteer firefighters. A two-arm cluster randomized controlled trial was conducted across 23 volunteer fire departments. Departments were assigned to a 6-month online intervention (health letters, moderated chat room, and a 45-minute summary course) or a waitlist control. Firefighters completed the 20-item Firefighter Exposure to Carcinogens Scale (FECS) at baseline and 6 months, assessing intention, perceived importance, behavior, and barriers. A total of 115 firefighters enrolled; participant retention rates were 48.39% in the intervention group and 81.13% in the control group. The intervention group showed greater improvement in perceived importance (p = .04) and a trend toward reduced perceived barriers (p = .05). Intention scores trended positively (p = .08). Behavioral changes were not significant in the primary analysis, but when clustering was accounted for, behavior improvement reached significance (p = .01). Perceived barriers were negatively correlated with intention, importance, and behavior, with stronger correlations post-intervention. The intervention was feasible and showed potential to improve cancer prevention-related perceptions and behaviors. Recruitment challenges indicate the need for enhanced engagement strategies. Online educational programs may support scalable cancer prevention training for volunteer fire departments, especially for rural and resource-limited settings.

Abstract BACKGROUND: Triple negative breast cancer (TNBC) represents 15-20% of all newly diagnosed breast cancers. This form of the disease, which tends to have a higher mutational burden, responds favorably to modern systemic immunotherapy. As a systemic treatment, immunotherapy is associated with rare but potentially life-threatening side-effects. For local, early-stage disease there may be an opportunity to employ targeted intralesional immunotherapy. Preliminary data suggests that intralesional injection of interleukin 2 (IL-2) may be able to produce a favorable pathologic response in TNBC. However, there are currently no protocols for the study of intralesional IL-2 in early-stage TNBC breast cancer. METHODS: This is a single-center, single-arm, non-randomized experimental trial with an initial target enrollment of 10 patients. Women 18-80 years of age with a <2 cm TNBC confirmed on diagnostic imaging and core biopsy are eligible. Patients with major organ dysfunction, history of immune related disease or immunomodulating medication are excluded. In the window-of-opportunity between initial consultation and definitive surgery (<6 weeks), eligible women receive weekly (x4), image-guided (ultrasound), intralesional injections of IL-2. Dose calculation per injection is 500,000 IU (5 million IU/ml) per millimetre of tumor width at index diagnostic imaging to a maximum dose of 15 million IU per injection. The primary outcome is pathologic response as defined by the residual cancer burden (RCB) score on final pathology. Secondary outcomes include, protocol feasibility and adverse events (Common Terminology Criteria for Adverse Events). Final pathological specimens will be evaluated for tumor infiltrating lymphocytes (TILs) and PD-L1 expression, in addition to RCB score. EXPECTED OUTCOME: We expect four weekly injections of intralesional IL-2, at a dose of 500,000 IU per mm of maximum tumor width, to be safe and well tolerated in this cohort of patients. Moreover, we anticipate this protocol will demonstrate treatment response characterized by tumor cell death and increased TILs. FUTURE DIRECTIONS: This study will generate preliminary data necessary to support a larger, adequately powered phase II trial to explore treatment optimization and efficacy. Future studies may explore other forms of intralesional immunotherapy, such as PD-L1 inhibitors, and mechanisms to enhance treatment response. Citation Format: R. Hemsworth, G. Knapp, A. Mayo, H. Stewart, A. Goyal, G. Bethune, K. Greenlaw, Z. Kellow, L. Helyer, A. Drohan. Intralesional Injection of IL-2 Prior to Surgery in Early-Stage Triple Negative Breast Cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-10-25.

Transferring adolescents with epilepsy (AWE) to adult care is a complex process, yet there is limited data on its overall epidemiology and clinical implications. This population-based study analyzes the long-term clinical trajectories and predictors of transfer among AWE within a robust Finnish healthcare system. A cohort of 439 AWE was followed for a mean of 10.28years. Transfer outcomes, care settings, and long-term seizure control were evaluated for patients reaching transfer age, focusing on predictors of public adult specialty care. Of 222 AWE reaching transfer age, 189 (85.1%) were transferred to adult services, with 64% entering university hospital care. Remission was achieved in 23% during extended follow-up, while 27% remained drug-resistant. Multivariable analysis identified developmental and epileptic encephalopathy, specific developmental disorders, and comorbidities such as asthma, allergies, and obesity as significant predictors for public adult specialty care. Notably, changing the transfer age from 16 to 18years had no significant effect on transfer rates. Transfer to adult specialty care affects the vast majority of AWE, imposing considerable demands on public health systems. These findings underscore the need for early identification of high-risk patients to inform resource planning and individualized care strategies.

Birth weight is an important determinant of infant growth and development associated with neonatal morbidity (e.g., respiratory distress, hypoglycemia) and mortality, as well as long-term health risks such as developmental delays and chronic conditions (e.g., asthma, type 2 diabetes) in later life. These adverse health outcomes are particularly concerning when infants are born small or large for their gestational age. A potential strategy to improve optimal birth weight is preconception care, with consistent evidence demonstrating a relationship between maternal preconception health and infant birth weight. However, little attention has been given to the influence of paternal preconception health on pregnancy outcomes. This scoping review aimed to capture the existing literature and highlight evidence gaps regarding associations between paternal preconception health and infant birth weight. We followed the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. The review considered studies that included men in the preconception period who identified as the parent of a child for whom infant birth weight outcomes were reported. Medline, PsycINFO, Embase, Scopus and CINAHL databases were searched to June 30, 2024. Two independent reviewers screened the titles/abstracts and full-text articles. Data extraction was performed independently by two researchers using a standardized form in Covidence. The data were synthesized narratively according to the paternal preconception health factors identified within the included studies (e.g., physical well-being, health behaviors, substance use, environmental exposures, mental health, and treatment effects). From 7,690 citations, 57 published studies were included in the review. Most studies were conducted in China (n = 18, 31.6%) or the United States (US) (n = 17, 29.8%) and used a cohort design (n = 54, 94.7%). Our review identified growing evidence that specific paternal preconception factors, such as physical well-being (e.g., BMI, physical health), certain medications (e.g., recreational drugs, sulfonylureas, diazepam), and environmental chemical exposure, may adversely influence infant birth weight. There are mixed findings related to other paternal health factors, including some health behaviors (e.g., nutrition, sleep, physical activity), substance use, and mental health. Consideration should be given to expanding preconception counseling and public health initiatives to include fathers, to improve paternal health and potentially reduce risks to offspring (e.g., birth weight). We also identified key areas where further research is required to advance knowledge in this field.

The PIONIR (Preventing IBD ONset in Individuals at Risk) trial evaluates whether the Tasty&Healthy diet can reduce risk of Crohn's disease (CD) development in first-degree relatives (FDRs). The optimal preclinical stage of CD for enrolling subjects to prevention trials is unknown. We aimed to propose a framework for identifying high-risk participants for prevention trials by reporting the outcomes of the pre-PIONIR screening stage. Faecal calprotectin was measured in asymptomatic FDRs aged 6-38 years; those with persistent elevation, defined as >70 µg/g in at least two separate tests, were offered panenteric video capsule-endoscopy or ileocolonoscopy. Of 950 FDRs approached, 331 (35%) agreed to be screened: 63 (19%) had persistently elevated calprotectin, of whom 42 underwent further evaluation. Nine (2.7%) had endoscopic appearance compatible with presymptomatic CD, 22 (6.6%) had non-specific macroscopic mucosal changes and 11 (3.3%) had normal mucosa despite elevated calprotectin, suggesting probable histological inflammation. The 33 participants in the two latter groups were defined as 'potential pre-CD' (17.9% of all screened after adjusting for missing values). Calprotectin >225 µg/g predicted presymptomatic CD (area under the receiver operating characteristic curve 0.97 (95% CI 0.94 to 1.0; p<0.001; sensitivity 89%, specificity 94%). Of those with a single elevated calprotectin value, 22% normalised on repeat testing with significant variability (intraclass correlation coefficient 0.72 (95% CI 0.57 to 0.82)). Approximately one in five asymptomatic FDRs had persistently elevated calprotectin, which was able to differentiate those with presymptomatic CD. The findings highlight calprotectin's utility in identifying at-risk individuals during the potential pre-CD stage for enrolment in prevention trials.

Anterior vertebral body tethering (AVBT) is a promising fusionless alternative for treating idiopathic scoliosis; however, limited data exist on the learning curve for this procedure. Previous studies are limited by single-center and short-term complication data. This multicenter study assesses the learning curve by evaluating improvements in operative characteristics over time and radiographic measurements up to 2 years postoperatively. As recorded from a multicenter registry, surgeons with ≥10 index AVBT procedures for patients with idiopathic scoliosis aged 16 years and below were included. Relationships between case number and multiple surgical variables were determined using Pearson correlation and linear regression testing. For identification of an inflection point, consecutive cases were plotted against operative time per level and fitted with a locally weighted scatterplot smoothing curve. Independent samples t test and χ 2 test were used to compare outcomes between cases before and after the inflection point. Outcomes of interest included demographic, surgical, and radiographic information at the baseline, immediate postoperative, and 2-year timepointswhere available. Eight surgeons and 325 index AVBT patients met the inclusion criteria. Inverse relationships were identified between case number and estimated blood loss, operative time, anesthesia time, and fluoroscopic time per level ( P < 0.005). The inflection point was identified at 15 cases. Operative time, anesthesia time, and fluoroscopy time per level were greater in the first 15 cases compared with those after ( P < 0.05). There were no significant differences in demographic variables, intraoperative complications, or length of stay between the early and late cases. Greater correction in the major coronal curve, minor coronal curve, and coronal balance occurred in the cases performed after the inflection point ( P < 0.05). AVBT is a safe alternative to posterior spinal fusion and demonstrates a predictable improvement in surgical performance over time. Large improvements can be expected during the first 15 AVBT cases performed with minimal differences in complications. Level III.

Background:Caring for children at the end of life is a reality of practice in the pediatric intensive care unit (PICU). Learning how to make sense of death at work, and the emotions it entails, is necessary for all PICU professionals.Objective:To explore how PICU clinicians manage their emotions when encountering pediatric death at work.Design:Exploratory qualitative study grounded in interpretive phenomenology and the theoretical lens of emotional labor. We conducted one-time semi-structured interviews. Once transcribed, we inductively coded interview transcripts and subsequently generated themes through reflexive thematic analysis.Methods:Fifteen clinicians (n = 3 respiratory therapists; n = 3 physicians; n = 3 child life specialists; n = 2 nurses; n = 2 physiotherapists; n = 2 social workers) practicing in Canadian PICUs. The majority identified as women (n = 13). Four participants self-identified as Black, Indigenous, and/or a person of color.Results:We generated four themes that influenced how clinicians managed emotions related to death in PICU: (1) Figuring it out on the job; (2) Reframing and rationalizing death; (3) Managing emotions as quality end-of-life care; (4) Navigating organizational constraints. Although clinicians shared many strategies and resources for managing emotions, the ability to apply these strategies was impacted by systemic constraints (e.g., pace of work, understaffing) and unequal access across professions to unit-level resources.Conclusion:Navigating pediatric death in the workplace requires skilled emotional labor, and clinician access to appropriate support to manage its impacts, which varies by unit culture and profession. PICU leaders should facilitate unit- and individual-level supports that are inclusive of all team members.

Abstract Background Audit and feedback (A&amp;F) is a widely used quality improvement strategy to modify healthcare professionals’ practice. However, there is considerable variation in how A&amp;F is applied and in its effectiveness. Investigating this variation, in terms of differences in the behaviour change techniques (BCTs) interventions employ, and why it occurs may provide insights for optimising intervention design. This study, therefore, explored associations between which BCT are used in A&amp;F interventions, behaviour change direction (implementation vs. de-implementation), and target behaviour type. Methods An exploratory secondary analysis was conducted on data from 261 randomized trials of A&amp;F interventions, originally extracted as part of a Cochrane systematic review. Regression analyses investigated whether different BCTs were used for implementation versus de-implementation. These analyses were repeated in subgroups of different behaviour types (e.g., prescribing, testing/examinations). Parallel analyses aggregated data at the study level to assess the robustness of findings. Results Analyses on the whole sample demonstrated that the same BCTs were used to implement and de-implement target behaviours in A&amp;F interventions. Subgroup analyses identified potential associations between specific BCTs and implementation direction within certain behaviour types: social comparison with implementation of treatment decisions/actions; education (unspecified) with implementation of testing/examinations; social support (unspecified) with implementation of prescribing; and feedback on outcome of behaviour with de-implementation of treatment decisions/actions. However, these associations were not consistently replicated across the main and parallel analyses, and may reflect prevailing design practices or methodological artefacts rather than genuine differences in BCT selection. Conclusions This study demonstrated that, overall, A&amp;F interventions utilise similar BCTs regardless of whether behaviours are being implemented or de-implemented. However, exploratory subgroup analyses suggest that tailoring interventions through selectively using certain BCTs for either implementation or de-implementation, depending on the type of behaviour being acted on, may warrant further investigation. Future research should test these hypotheses using theory-informed intervention designs and robust methods, to determine whether current patterns of BCT use reflect true differences in intervention effectiveness.

IntroductionDistal radius fractures are the most common fractures seen in the emergency department in children in the USA. However, no established or standardised guidelines exist for the optimal management of completely displaced fractures in younger children. The proposed multicentre randomised trial will compare functional outcomes between children treated with fracture reduction under sedation versus children treated with simple immobilisation.Methods and analysisParticipants aged 4–10 years presenting to the emergency department with 100% dorsally translated metaphyseal fractures of the radius less than 5 cm from the distal radial physis will be recruited for the study. Those patients with open fractures, other ipsilateral arm fractures (excluding ulna), pathologic fractures, bone diseases, or neuromuscular or metabolic conditions will be excluded. Participants who agree to enrol in the trial will be randomly assigned via a minimal sufficient balance algorithm to either sedated reduction or in situ immobilisation. A sample size of 167 participants per arm will provide at least 90% power to detect a difference in the primary outcome of Patient-Reported Outcomes Measurement Information System Upper Extremity computer adaptive test scores of 4 points at 1 year from treatment. Primary analyses will employ a linear mixed model to estimate the treatment effect at 1 year. Secondary outcomes include additional measures of perceived pain, complications, radiographic angulation, satisfaction and additional procedures (revisions, refractures, reductions and reoperations).Ethics and disseminationEthical approval was obtained from the following local Institutional Review Boards: Advarra, serving as the single Institutional Review Board, approved the study (Pro00062090) in April 2022. The Hospital for Sick Children (Toronto, ON, Canada) did not rely on Advarra and received separate approval from their local Research Ethics Board (REB; REB number: 1000079992) on 19 July 2023. Results will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings.Trial registration numberNCT05131685.

Digital health solutions are often used to support caregivers in managing acute pain in their children. The aim of this scoping review was to identify, characterize, and synthesize the literature on caregiver-targeted digital health solutions for acute pain management in children as it relates to caregiver, child, and implementation outcomes. Studies must have described a caregiver-targeted digital health solution for acute pain management in children that provides information or support to caregivers of children experiencing acute pain (eg, needle-related procedure, injury, medical procedure). Studies that included caregivers of children 0 to 19 years were eligible. Following the Joanna Briggs Institute scoping review methodology, MEDLINE, Embase, CINAHL, and PsycINFO databases were searched from January 1, 2010 to May 20, 2025. Two reviewers completed screening and data extraction, and a third reviewer resolved disagreements. From 8949 records screened, 33 studies were eligible. From these, there were 15 individual digital health solutions identified. Of the 7,125 caregivers, 95.2% were mothers. More than half of digital health solutions targeted caregivers of newborns (0-1 years, 60.6%), and all except 2 focused on acute pain during needle-related procedures (eg, vaccinations). Overall, 21 studies reported on caregiver outcomes (primarily knowledge), 11 reported on child outcomes (primarily pain and distress), and 28 reported on implementation outcomes (primarily adoption and acceptability). There is a need for (1) standardization in the evaluation of digital health solutions for caregivers, (2) digital health solutions that target acute pain other than needle-related procedures, and (3) increased diversity of caregivers (eg, non-White, non-mothers) and solutions (eg, culturally diverse).